腎尿路奇形, 尿路変向後の症例に対する, 逆行性尿路結石破砕術の安全性と有効性についての検討

Abstract

Retrograde ureterorenoscopic lithotripsy is one of the first-line therapies for urolithiasis. In some cases, however, thisapproach may be difficult to adopt because of factorss uch asrenal/ureteral anatomic abnormalities or urinary diversion. This study aims to investigate the safety and efficacy of retrograde ureterorenoscopic lithotripsy in patients with the above-mentioned conditions. We retrospectively investigated all such patients who underwent retrograde ureterorenoscopic lithotripsy from May 2009 to December 2019 at our hospital. "Stone free"was defined as the total absence of residual fragments, and "success"wasdefined asthe absence of hydronephrosisand residual fragmentsgreater than 4 mm at the end of 4 weeks. Complications were classified according to the modified Clavien-Dindo classification system. Twenty-one procedureswere performed in 19 patientswhos e conditionswere horseshoe kidney, ureteral duplex, cross-fused renal ectopia, cutaneous ureterostomy, ileal conduit, ureterocystoneostomy, and cystostomy. The median age was 67 (40-93) years, the median stone diameter was 9.6 (5.0-16.0) mm, the median operation time was 63 (12-158) minutes, and the complete stone-free rate and success rate were 42.9 and 71.4%, respectively. The complication rate was 19.0% ; however, no serious complications were observed. In conclusion, retrograde ureterorenoscopic lithotripsy is an effective and safe procedure for patientss uffering from urolithiasis with renal/ureteral anatomic abnormalitiesor previousurinary diversion.